Acne is a dermatological disorder which is more prevalent in adolescence and is found mainly within the age group of about 15 to 22. As it occurs primarily in the face and trunk areas, affecting the appearance of the patient, it probably causes more mental pain and anguish to those afflicted than many other diseases which, from a physical standpoint, may be much more severe. The basic lesion of acne is the comedo or "blackhead" of a pilosebaceous follicle. The condition may be mild and transient with only a few blackheads which can easily be ejected by pressure and are of little concern, or may be severe, persistent, and very disfiguring with the more serious cases frequently leaving permanent scarring.
There have been many treatments proposed for acne, almost any treatment giving some relief. What appears to occur in the development of acne is that there is an initial filling up of the follicle with a rather tough, keratinous material. The impactation of horny material is the whitehead and blackhead. As a result of bacterial growth in these horny impactations, the follicle ruptures initiating the inflammatory phase of the disease which takes the form of pustules, papules, cysts and nodules.
One of the commonly used methods for acne treatment is the use of peeling agents which cause exfoliation with the removal of some of the keratinous plugs. In the more serious cases where pustular or cystic lesions exist, the same are evacuated by incision and the contents expressed. Various other therapies have been employed, such as vaccine therapy, to assist in the control of chronic infection and increase the patient's resistance to Staphylococcis; hormone therapy, which is applicable only for female patients who may be put on routine contraceptive regimen with estrogen; antibacterial therapy for the treatment of extensive pustular or cystic acne where the patient may be treated with tetracyclines, penicillin, erythromycin, or other of the antibacterial agents and, in some instances, general surgical skin planing may be used.
The administration of large oral doses of vitamin A has been suggested as being beneficial in acne, Staumford, J. V.: "Vitamin A: Its Effects on Acne," Northwest Med., 42; 219-225, August 1943), although other investigators have felt it to be ineffective (Anderson, J. A. D. et al, "Vitamin A in Acne Vulgaris," Brit. Med. J. 2: 294-296, August 1963; Lynch, F. W. et al, "Acne Vulgaris Treated With Vitamin A," Arc Derm. 55: 355, 357, March 1947, and Mitchell, G. H. et al, "Results of Treatment of Acne Vulgaris by Intramuscular Injections of Vitamin A," Arch. Derm., 64: 428-430, October 1951).
Vitamin A acid has been applied topically. Beer (Beer, Von P., "Untersuchungen uber die Wirkung der Vitamin A-Saure," Dermatologica, 124: 192-195, March 1962) and Stuttgen (Stuttgen, G., Zur Lokalbehandlung von Keratosen mit Vitamin A-Saure," Dermatologica, 124: 65-80, February 1962) reported achieving good results in those hyperkeratotic disorders which are responsive to high oral doses of Vitamin A. Among those treated by Beer and Stuttgen were patients with acne; however, these investigators reported no effective results on this disorder. British Patent 906,005 discloses a cosmetic peparation containing vitamin A acid for regulation of the cornification processes of human-skin. However, this treatment also results in great irritation to the skin, which severely limits its usefullness.
In U.S. Pat. No. 4,595,696 certain polyenes are described as being useful in treating inflammatory or allergic conditions. These conditions are far afield of acne and materials useful for the treatment of inflammatory conditions are not expected to be useful in the treatment of acne and vice versa.
In addition, it has been reported in "Arotinoid Ro 13-6298 and Etretin: Two New Retinoids Inferior to Isotretinoin in Sebrum Suppression and Acne Treatment", by Harms, M. et al, Acta Derm Venereol (Stockh) 1986; 66: 149-154, that extremely close analogs of retinoic acid are not effective in the treatment of acne. This illustrates the unpredictability of these compounds to treat acne.